Provider Demographics
NPI:1558925487
Name:JED M. KOOPS, DMD, LLC
Entity Type:Organization
Organization Name:JED M. KOOPS, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOOPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-941-7824
Mailing Address - Street 1:3028 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2441
Mailing Address - Country:US
Mailing Address - Phone:440-941-7824
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 515
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4466
Practice Address - Country:US
Practice Address - Phone:216-464-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental